The treatment of fractures was originally conservative. Improvements in materials and surgical techniques and new insights into the biological aspects of fracture healing led to an increase of surgical treatment of fractures. The main breakthrough of osteosynthesis took place with the foundation of the Arbeitsgemeinschaft für Osteosynthesefragen (Study Group for Problems in Osteosynthesis) which had as its basic principles anatomical repositioning, stable internal fixation, atraumatic surgical technique and early mobilization. In general, surgical treatment is indicated for periarticular fractures, open fractures, fractures complicated by nervous or vascular lesions, pathological fractures and fractures in multiple injury patients. The question who should practise traumatology, the general or the orthopaedic surgeon, was initially a point of controversy; by now, cooperative teams have been formed based on appreciation of one another's qualities. The trend for the near future appears to be minimally invasive surgery, with indirect repositioning and fixation techniques and biological methods of stimulating fracture healing.